| NPI | 1730537689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PR 21679) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 21679) |
| 208000000X Pediatrics (Licence: PR 21679) | |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2022-11-28 |